Organization
CANNON COUNTY AMBULANCE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN HARRIS (DIRECTOR)
(615) 653-2655
Entity
Organization
Contact information
Practice address
104 ALEXANDER DR, WOODBURY, TN 37190-5275
(615) 563-5959
(615) 563-6878
Mailing address
PO BOX 9150, PADUCAH, KY 42002-9150
(270) 744-9600
(270) 744-8642
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
—
—
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2007454
TENN CARE NON EMERGENCY
TN
05
—
3525445
—
TN
01
—
4110424
TENN CARE EMERGENCY
TN
Enumeration date
02/09/2006
Last updated
06/21/2022
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